CR PBLs

Question 1

Types of CoA

Answer 1

Pre-ductal
Juxtaductal
Post-ductal

Question 2

Which type of CoA is most common?

Answer 2

Juxtaductal

Question 3

Defects associated with CoA

Answer 3

Left sided obstructive defects
VSD
Bicuspid aortic valve
Aortic arch hyperplasia

Question 4

Surgical treatments for CoA

Answer 4

Resection and end-end anastomosis
Patch aortoplasty
Left subclavian flap angioplasty
Bypass graft repair

Question 5

Symptoms of second degree heart block

Answer 5

Lightheadedness, dizziness, syncope
Chest pain
Irregular heart beat
Bradycardia

Question 6

Causes of heart block

Answer 6

Electrolyte imbalances 
MI 
Coronary artery disease
Myocarditis or cardiomyopathy 
Heart enlargement from heart failure

Question 7

Indications for pacemaker in heart block

Answer 7

Persistant bradycarida
Asystole for >3 seconds
Heart failure
Associated with neuromuscular disease

Question 8

When is CRP commonly raised?

Answer 8

Late pregnancy
Mild inflammation
Bacterial and viral infection
Burns

Question 9

Reversible risk factors or angina

Answer 9

Smoking 
Hypertension 
Hyperlipidameia 
Obesity 
Physical inactivity

Question 10

Irreversible risk factors for angina

Answer 10

Family history
Older age
Male sex
Diabetes mellitus

Question 11

Signs of angina on ECG stress test

Answer 11

ST depression
T wave inversion
Short and spikey T waves

Question 12

Drugs used in angina treatment

Answer 12

Aspirin
CCBs
BBs
Statins 
Nitrates 
Beta blockers 
ACEIs
ARBs

Question 13

Characteristics of unstable angina

Answer 13

Pain comes on suddenly
Not triggered by exertion
Does not go away with rest
Gets worse over a short period of time

Question 14

ST elevation

Answer 14

= ongoing active damage
>2mm in chest leads
>1mm in limb leads
Must be present in 2 or more contiguous leads

Question 15

Pathological Q waves

Answer 15

= irreversible damage 
>0.04s
>2 small squares in depth 
>25% of the depth of the QRS complex 
Present in V1-3

Question 16

Troponin subtypes

Answer 16

T and I

Question 17

When is troponin released and when do levels return to normal?

Answer 17

First released 4-6 hours after attack

May remain elevated for 2 weeks

Question 18

Myocardial creatine kinase

Answer 18

= CK-MB

Question 19

When is CK released and when do levels return to normal?

Answer 19

3-12 hours after infarct

Return to normal after 48-72 hours

Question 20

When is AST released and when do levels return to normal?

Answer 20

Peaks around 48 hours

Returns to normal after 5 days

Question 21

When is LDH released and when do levels return to normal?

Answer 21

Peaks around 72 hours

Returns to normal after 6 days

Question 22

When is myoglobin released?

Answer 22

As early as 2 hours after infarct

Question 23

Pain felt in AMI

Answer 23

Intense and consistent for 30-60 minutes
Retrosternal
Radiates --> neck, jaw, back, arm
May be felt as indigestion 
Felt as a weight on the chest as squeezing pain

Question 24

AMI immediate treatment

Answer 24

Aspirin
Pain relief and sedation
Thrombolysis or PCI
Beta blockers

Question 25

Secondary prevention

Answer 25

Aspirin Beta blocker Statin ACEI

Question 26

Short term complications of AMI

Answer 26

Arrhythmia Heart failure Rupture Mural thrombosis

Question 27

Long term complications of AMI

Answer 27

Aneurysm Heart failure Pericarditis

Question 28

Adverse prognostic features of AMI

Answer 28

``` Advanced age Anterior AMI Larger AMI Heart failure Systolic hypotension Complex ventricular arrhythmias >24h after infarct History of previous infarct(s) ```

Question 29

Causes of heart failure

Answer 29

``` Coronary artery disease Valve disease Cardiomyopathy Congenital defects Toxins (alcohol, cocaine) Drugs (BBs, CCBs) Anaemia Pregnancy Hyperthyroidism ```

Question 30

Major criteria for heart failure

Answer 30

``` PND Weight loss with treatment Neck vein distention Hepatojugular reflux Rales S3 gallop Cardiomegaly ```

Question 31

Minor criteria for heart failure

Answer 31

``` Nocturnal cough Dyspnoea on normal exertion Decrease in VC by 1/3 Pleural effusion Tachycardia Bilateral ankle oedema ```

Question 32

Why do you get PND?

Answer 32

Return of peripheral oedema fluid to circulation due to gravity Reduced respiratory drive during sleep Reduced sympathetic bronchodilation during sleep

Question 33

ECG features of heart failure

Answer 33

LVH (high R waves in V4-6) ST depression showing ischaemia LBBB

Question 34

CXR findings

Answer 34

``` Cardiomegaly Bat wing sign Kerley B lines Pleural effusions Upper lobe diversion ```

Question 35

Echo findings

Answer 35

``` Reduced eject fraction Dilated ventricles Valve dysfunction Pulmonary artery pressure raised Reduced/increased wall thickness ```

Question 36

Drugs for heart failure

Answer 36

``` Diuretics ACEIs Beta blockers ARB Aldosterone blocker Digoxin ```

Question 37

Heart failure prognosis

Answer 37

50% die within 5 years

Question 38

Asthma characteristics

Answer 38

Airflow limitation Airway hyper responsiveness Inflammation on bronchi

Question 39

Raised cells in asthma

Answer 39

Eosinophils Mast cells T cells

Question 40

Signs of severe asthma

Answer 40

``` SaO2 <92% PEFR <33% predicted Tachycardia PaO2 <8kPa PaCO2 normal or raised Silent chest Cyanosis Inability to complete sentences in one breath Feeble respiratory effort ```

Question 41

Treatment ladder of asthma

Answer 41

``` Salbutamol Inhaled steroid LABA Leukotriene antagonist Antimuscarinic Theophylline Oral steroid ```

Question 42

Risk factors for DVT

Answer 42

``` Previous DVT Hospitalisation Surgery Active cancer Lower limb trauma Increasing age Pregnancy COCP/HRT Obesity Thrombophilia Long haul travel Family history ```

Question 43

Signs and symptoms of DVT

Answer 43

``` Limb pain Tenderness Swelling Pitting oedema Distention of superficial veins Increased temperature Erythema Cord like palpable vein ```

Question 44

What is D dimer?

Answer 44

Breakdown product of cross-liked fibrin produced by plasmin

Question 45

DVT treatment

Answer 45

LMWH then warfarin

Question 46

Complications of DVT

Answer 46

PE Active bleeding from treatment Post-thrombotic syndrome Heparin induced thrombocytopaenia

Question 47

Forms of embolus

Answer 47

``` DVT Fat Air Amniotic fluid Tumour ```

Question 48

Symptoms of PE

Answer 48

Dyspnoea Pleuritic chest pain Haemoptysis

Question 49

Atypical symptoms of PE

Answer 49

``` Syncope Seizures Abdominal pain Fever Confusion Delirium ```

Question 50

Signs of PE

Answer 50

``` Tachycardia Tachypnea Hypoxia Pyrexia Raised JVP Pleural rub Accentuated second heart sound Hypotension and shock ```

Question 51

Differential diagnosis of PE

Answer 51

``` Pneumonia Acute coronary syndrome Aortic dissection Cardiac tamponade Pneumothorax ```

Question 52

ECG signs of PE

Answer 52

``` Tachycardia RBBB RV strain RAD Large P waves S1Q3T3 pattern Atrial arrhythmia ```

Question 53

CXR signs of PE

Answer 53

``` Dark lung fields Focal oligaemia Prominent central artery Basal wedge shaped opacities Pleural effusion ```

Question 54

Type of respiratory failure in PE

Answer 54

1

Question 55

Treatment of PE

Answer 55

Heparin or fondaparinux Then warfarin Thrombolysis in massive PE

Question 56

Can thrombolysis be used in pregnancy?

Answer 56

YES

Question 57

Sites of RBC production

Answer 57

Yolk sac Liver and spleen Bone marrow

Question 58

Forms of haemoglobin

Answer 58

Hb Gower 1 = zeta 2 epsilon 2 HbF = alpha 2 gamma 2 HbA = alpha 2 beta 2 HbA2 = alpha 2 delta 2

Question 59

Genetics of alpha thalassaemia

Answer 59

Gene deletions on chromosome 16 | Usually 4 genes present

Question 60

Consequences of alpha thalassaemia

Answer 60

1-2 deletions = no symptoms 3 deletions = HbH disease --> severe microcytic anaemia 4 deletions = hydrops foetalis --> death

Question 61

Hb levels in beta thalassaemia major

Answer 61

Low HbA High HbF Normal or slightly high HbA2

Question 62

Sites of extra medullary haematopoiesis

Answer 62

Spleen | Liver

Question 63

Consequences of haemolysis

Answer 63

Jaundice Reticulocytosis Hepatosplenomegaly

Question 64

Treatment of beta thalassaemia major

Answer 64

Regular blood transfusions Iron chelation therapy Bone marrow transplant Splenectomy

Question 65

Iron chelating agents

Answer 65

Desferrioxamine (SQ) | Deferiprone (oral)